Difference between revisions of "Dabigatran reversal"

(Life-Threatening Bleeding)
(Text replacement - "OR" to "'''OR'''")
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==Mild Bleeding==
==Mild Bleeding==
*Local control measures: direct pressure
*Local control measures: direct pressure
*Delay next 1-2 doses OR discontinue (as appropriate)
*Delay next 1-2 doses '''OR''' discontinue (as appropriate)
==Moderate-Severe Bleeding==
==Moderate-Severe Bleeding==

Revision as of 22:26, 30 May 2017


  • If aPTT is <1.5 x control, it is unlikely that significant drug effect is present
  • Thrombin Time (TT) is most sensitive; normal TT excludes presence of significant dabigatran

Mild Bleeding

  • Local control measures: direct pressure
  • Delay next 1-2 doses OR discontinue (as appropriate)

Moderate-Severe Bleeding

  • Local control measures: direct pressure/surgical intervention
  • Resuscitate with intravenous fluid and / blood products
  • Oral charcoal administration if drug taken <2 hours before presentation
  • Hemodialysis will remove ~60% of drug taken over prior 2-3 hours
  • Consider Idarucizumab (Praxbind): 5 grams IV

Life-Threatening Bleeding

In addition, consider above PLUS

  • Consider FEIBA[1]
  • Consider Recombinant Factor VIIa (no good data)
  • Consider Kcentra (PCC): 50 IU/kg IV bolus[2]
  • Consider Tranexamic acid

See Also


  1. Dager WE, Gosselin RC, Roberts AJ. "Reversing dabigatran in life-threatening bleeding occurring during cardiac ablation with factor eight inhibitor bypassing activity". Crit Care Med. 2013 May;41(5):e42-6.
  2. Eerenberg ES, et al. "Reversal of Rivaroxaban and Dabigatran by Prothrombin Complex Concentrate: A randomized, placebo-controlled, crossover study in healthy subjects". Circulation. 2011 Sep 6.